Prevalence of Equinus in Diabetic versus Nondiabetic Patients

Frykberg, Robert G.; Bowen, Joel; Hall, Jared; Tallis, Arthur; Tierney, Edward F.; Freeman, Denise

doi:10.7547/1020084

Cited by 44 publications

(27 citation statements)

References 24 publications

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“…They found that approximately 10% of those with diabetes also had ankle equinus and significantly higher forefoot plantar pressures compared with those with diabetes but no equinus deformity. Frykburg et al reported that ankle equinus was present in 25% of their study population of 102 people, 43 of which had diabetes and 59 without diabetes [3]. Ankle equinus was more prevalent in the diabetes group with 37% having this deformity, compared with only 15% of the nondiabetes group.…”

Section: Introductionmentioning

confidence: 92%

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Is there still a place for Achilles tendon lengthening?

Tagoe

Reeves

Bowling

2016

Diabetes Metabolism Res

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Patients with diabetes and ankle equinus are at particularly high risk for forefoot ulceration because of the development of high forefoot pressures. Stiffness in the triceps surae muscles and tendons are thought to be largely responsible for equinus in patients with diabetes and underpins the surgical rationale for Achilles tendon lengthening (ATL) procedures to alleviate this deformity and reduce ulcer risk. The established/traditional surgical approach is the triple hemisection along the length of the Achilles tendon. Although the percutaneous approach has been successful in achieving increases in ankle dorsiflexion >30°, the tendon rupture risk has led to some surgeons looking at alternative approaches. The gastrocnemius aponeurosis may be considered as an alternative because of the Achilles tendon's poor blood supply. ATL procedures are a balance between achieving adequate tendon lengthening and minimizing tendon rupture risk during or after surgery. After ATL surgery, the first 7 days should involve reduced loading and protected range of motion to avoid rupture, after which gradual reintroduction to loading should be encouraged to increase tendon strength. In summary, there is a moderate level of evidence to support surgical intervention for ankle joint equinus in patients with diabetes and forefoot ulceration that is non-responsive to other conservative treatments. Areas of caution for ATL procedures include the risk for overcorrection, tendon rupture and the tendon's poor blood supply. Further prospective randomized control trials are required to confirm the benefits of ATL procedures over conservative care and the most optimal anatomical sites for surgical intervention.

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Section: Introductionmentioning

confidence: 92%

“…Frykburg et al . reported that ankle equinus was present in 25% of their study population of 102 people, 43 of which had diabetes and 59 without diabetes . Ankle equinus was more prevalent in the diabetes group with 37% having this deformity, compared with only 15% of the non‐diabetes group.…”

Section: Introductionmentioning

confidence: 99%

Is there still a place for Achilles tendon lengthening?

Tagoe

Reeves

Bowling

2016

Diabetes Metabolism Res

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“…If present, ulcers and equinus deformities are solved first, through excision and, respectively, tendon lengthening procedures. The necessity for the latter is assessed using the Silfverskiold test (mentioned in 5 articles, although 85% of the authors commence with lengthening, with 10.3% equinus prevalence in diabetics and 50% associated ulcers) [24,25]. Removing a major deforming force also allows improved intraoperatory mobility and plantigrade positioning.…”

Section: Alignment and Complementary Interventionsmentioning

confidence: 99%

Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

Ion

2018

Romanian Journal of Orthopaedic Surgery and Traumatology

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Introduction and purpose:Charcot neuroarthropathy defines a cluster of progressive lesions affecting the joints and bones, as well as the soft tissues of the foot in the context of diabetes, a pivotal role being attributed to peripheral neuropathy. Loss of sensation and proprioception, subsequent repeated trauma, muscle and autonomic nervous system impairment contribute to the alteration of the foot’s architecture and distribution of pressure, ultimately triggering ulceration and gangrene. The urge to avoid amputation has fueled the development of conservative and reconstructive techniques capable of delaying, if not preventing such negative outcomes. The purpose of this review was to present the most frequently used reconstruction procedures and the challenges arising in adapting them to particular foot morphologies and lesion stages. Methods:Literature search was conducted using PubMed, resulting in around 90 articles, multicenter studies and reviews, 26 of which were considered most relevant in providing the guidelines for orthopedic reconstruction and postoperative care in Charcot foot patients with diabetic neuropathy prevailing over arteriopathy. Results:The tarsometatarsal and metatarsophalangeal joints are most frequently affected. Closed reduction, arthrodesis, and tendon lengthening are key features of an efficient correction, alternatively accompanied by resections and tenotomies. Ulceration and callus debridement may also be necessary, while prolonged casting and immobilization remain obligatory. Conclusions:Most authors agree that stabilizing the deformities, optimizing the pressure on the soft tissues, and promoting the healing of potential lesions are the main purposes of the interventions. Prompt recognition and correction of Charcot foot deformities improve life quality and minimize the prospects of amputation.

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Section: Introductionmentioning

confidence: 99%

“…Limited ankle joint dorsiflexion (i.e., equinus deformity) is associated with elevated plantar pressures, which subsequently increases the risk of plantar ulceration in people with diabetes [ 16 , 17 ]. There is a threefold risk of equinus deformity in those with diabetes compared to those without [ 16 ]. This is thought to be a result of non-enzymatic glycosylation [ 4 , 18 , 19 ], which alters the structure and function of collagen within connective tissues, such as tendons and fascia, causing stiffness.…”

Section: Introductionmentioning

confidence: 99%

Tendon lengthening and fascia release for healing and preventing diabetic foot ulcers: a systematic review and meta‐analysis

Dallimore

Kaminski

2015

Journal of Foot and Ankle Research

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BackgroundDiabetic foot ulcers have a devastating impact on an individual’s health-related quality of life and functional status. Additionally, diabetic foot ulcers impose a significant economic burden on our health care systems as a result of complications such as infection, hospitalisation and amputation. The current gold standard treatment for diabetic foot ulcers is total contact casting. However, the rate of ulcer recurrence is high, indicating the need for more effective long-term treatment options. Therefore, the aim of this study was to systematically identify, critique and evaluate all literature investigating the effectiveness of Achilles tendon lengthening, gastrocnemius recession and selective plantar fascia release in healing and preventing diabetic foot ulcers.ReviewSearches were conducted in MEDLINE, CINAHL, AMED, EMBASE and The Cochrane Library from the earliest available date to November 2014. Methodological quality of included studies was assessed using the Downs and Black checklist. Data from randomised-controlled trials were analysed using random effects meta-analysis. For all other studies, data were analysed descriptively.Eleven studies (614 participants) were included in the review, with a median sample size of 29 participants. Meta-analysis of two randomised-controlled trials found that there was no statistically significant difference between Achilles tendon lengthening or gastrocnemius recession and total contact casting for time to healing of diabetic foot ulcers (mean difference, MD, 8.22 days; 95 % CI, −18.99 to 35.43; P = 0.55; I2 = 34 %) and the rate of ulcers healed (risk ratio, RR, 1.06; 95 % CI, 0.94 to 1.20; P = 0.34; I2 = 41 %). The rate of ulcer recurrence was significantly lower following Achilles tendon lengthening or gastrocnemius recession than total contact casting (RR, 0.45; 95 % CI, 0.28 to 0.72; P < 0.001; I2 = 0 %).ConclusionsAchilles tendon lengthening and gastrocnemius recession appear to be effective surgical treatments for healing diabetic foot ulcers. The rate of ulcer recurrence was lower following Achilles tendon lengthening or gastrocnemius recession procedures compared to total contact casting treatment alone. Therefore, these surgical procedures may provide viable treatment options for the management and prevention of diabetic foot ulcers. Further rigorous randomised-controlled trials with longer follow-up are required to determine the long-term effectiveness and safety of these procedures.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-015-0085-6) contains supplementary material, which is available to authorized users.

show abstract

Prevalence of Equinus in Diabetic versus Nondiabetic Patients

Abstract: Equinus may be more prevalent in diabetic patients than previously reported. Although we cannot prove causality, we found a significant association between equinus and ulceration.

Cited by 44 publications

References 24 publications

Is there still a place for Achilles tendon lengthening?

Is there still a place for Achilles tendon lengthening?

Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

Tendon lengthening and fascia release for healing and preventing diabetic foot ulcers: a systematic review and meta‐analysis

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